visual impairments and the effect on development · vision: 20/70‐20/200 in best eye with best...

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PresentedbyLisaAuwarter

VisualImpairmentsandtheEffectonDevelopment

MeetthePresenterLisaAuwarter,M.S.Ed.

Agenda

Overviewofvisualimpairments–ROP,ONH,SOD,

MuscleImbalance,OpEcAtrophy

DBVIservices

TheEffectsonInfant

Development

OverviewofCorEcalVisualImpairments

La Clinica Oculistica Virtuale

TheHumanEye

LowVision:20/70‐20/200inbesteyewithbestcorrecPon

Legallyblind:20/200orworseinbesteyewithcorrecPon

VisualAcuity:howclearlyweseethings

LowVision:20/70‐20/200inbesteyewithbestcorrecEonLegallyBlind:20/200orworseinbesteyewithcorrecEon

Whatdoyouthinkthisis?

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7

Visual Acuity: how clearly we see things

Low Vision: 20/70-20/200 in best eye with best correction Legally blind: 20/200 or worse in best eye with correction

Whatismyopia?

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Myopia or near sightedness

Normal vision

eyeatlas.com

20

Hyperopia or far sightedness

Astigmatism

eyeatlas.com

TheDiseaseProcessinRePnopathyofPrematurity

NaEonalEyeInsEtute,NaEonalInsEtutesofHealth

•  Retina has not yet vascularized

•  Growth stops for a while

•  Then oxygen can cause them to grow wildly, tangle and grow into vitreous, not to edges

•  Vessels hemorrhage, scar tissue forms and vitreous contracts, damaging retina and causing detachments

0‐5

StagesofROP

0‐3–mayneedglassescorrect

3,3+,4–lowvision

5–totaldetachment

NaEonalEyeInsEtute,NaEonalInsEtutesofHealth

Stages0‐5

  Braindamage

  CerebralPalsy

  Seizures

  HearingLoss

  LearningdisabiliEes

  CorEcal/Cerebral

  VisualImpairment

  SensoryIssues

OtherDisabiliPesandROP

  Canbeneurological(damagetothebrain)orduetoothervisionimpairment(i.e.,albinism,highmyopia)

  VerEcal,horizontalorrotary

  Slightlyblursvision,centralvisiondecreasedsoholdsobjectscloser

  Mayturnheadslightlytousenullpoint

  IncreaseswithfaEgue,stress,excitement

  Maydecreasewithage

Nystagmus

Haveyouworkedwithachildwithnystagmus?

Us!Tell

RandomorRovingEyeMovements

  Signofpooracuity;takesgoodacuitytofixate

  Asifeyesaretryingtofindatarget,butcan’tquitefocusonitwell

TheOpPcNerve

DamagedopEcnerve(hydrocephalusorIVH)

OpPcNerveAtrophy(ONA)

  LossofbloodsupplytoopEcnervewithgradualvisionloss

  OpEcdiscispale  Changeinvisualacuityandperipheralfieldmayoccurbeforechangeinthediscisevident;

  DegeneraEvecondiEonfollowingnormalfuncEon

  Notnormallydiagnosedininfancywww.nature.com

OpPcNerveHypoplasia(ONH)

  SmallopEcnerveswithnormalsizebloodvessels

  Varyingdegreesofvisualacuityandfieldlosses

  AssociatedwithCNSanomalies–agenesisofcorpuscallosum(failureoftwohalvesofbraintoconnect)–endocrinedisorders

  Incidenceincreasing,usedtobethoughtthatiswasaresultofdrugs,alcohol,tobaccouseofmotherbeforebirthwhilepregnantbutnolongertrue–couldbeenvironmentalthroughthefirsttrimester Booklet on ONH from the

Blind Childrens Center in Los Angeles, CA

SeptoOpPcDysplasiadeMorsiersyndrome

  AcongenitalmalformaEonsyndromemanifestedby:–hypoplasia(underdevelopment)oftheopEcnerve–hypopituitarism–absenceoftheseptumpellucidum(amidlinepartof–thebrain)

  Inaseverecase,thisresultsinpituitaryhormonedeficiencies,blindness,andintellectualdisability

  Therearemilderdegreesofeachofthethreeproblems,andsomechildrenonlyhaveoneortwoofthethree

emedicine.com

DelayedVisualMaturaPon

  associatedwithotheroculardisorderssuchasalbinism,cataractsoraniridia;visionworsethanexpectedmeanageofrecoveryat20weeks;

  onsetofnystagmusprecedesrecoveryby8months;also

  dependsonvisualabiliEesandothercharacterisEcsofthechild

  by3‐6months,childhasarapidimprovementofvisiontonormalornear‐normallevels

TypeI TypeII TypeIII

  visionusuallyimproves,buttakeslongerandtheremaybeconEnuedlossofvision

eyeatlas.com

EyeMuscleImbalances

OculomotorProblems

or

Oculomotorproblems?

WhatcanIdo?

CorPcalVisualImpairment

WhatisCorPcalVisualImpairment

(CVI)?

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CorPcalVisualImpairment(CVI)isatemporaryorpermanentvisualimpairmentcausedbythedisturbanceoftheposteriorvisualpathwaysand/ortheoccipitallobesofthebrain.Thedegreeofvisionimpairmentcanrangefromseverevisualimpairmenttototalblindness.ThedegreeofneurologicaldamageandvisualimpairmentdependsupontheEmeofonset,aswellasthelocaEonandintensityoftheinsult.ItisacondiEonthatindicatesthatthevisualsystemsofthebraindonotconsistentlyunderstandorinterpretwhattheeyessee.ThepresenceofCVIisnotanindicatorofthechild'scogniEveability.

IDEA?

IdenPficaPonandDiagnosis

 NormaleyeexamoreyecondiEonthatwouldnotexplainleveloffuncEoning

 Medicalhistorythatincludesneurologicalproblems

  PresenceofuniquevisualandbehavioralcharacterisEcs

PossibleCauses

  Asphysxiaandperinatalhypoxic‐ischemicencephalopathy

  IVH(preemiesarehighrisk)–bleedingintotheventricles

  PVL(periventricularleukomalacia)

  CerebralVascularAccident/CerebralArteryInfarcEon(brainbleed)

  InfecEon(TORCH–toxo,rubella,cmv,herpes)

  StructuralabnormaliEes(spinabifida,DandyWalker,microcephaly,lissencephaly)

  AcquiredCVI–TBI,acquiredhypoxia,accidents

UniqueCharacterisPcs

  Visuallatency  Lightgazingornonpurposefulgaze

  Difficultywithdistanceandvisualnovelty

  Visualandbehavioral  Colorpreferences  AfracEontomovement

Toy/objectonsolid

background

Toy/objectonpafernedbackground

vs.

  Difficultywithvisualandenvironmentalcomplexity–pairingsenses,movements,display

  Visualfieldpreferences

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.

Seeitnow?

CorPcalVisualImpairment

WhenachildwithCVIneedstocontrolhishead,usehisvision,andperformfinemotortasks,theeffortcanbecomparedtoaneurologicallyintactadultlearningtoknitwhilewalkingaPghtrope.

“

WhyisitimportanttoworkasateamwithchildrenwithcorEcalvisualimpairmentsinparEcular?

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TheEffectsofVisualImpairmentonDevelopment

HiMax!!

SensoryDevelopment

 Hearingistheonlydistancesenseavailable

  Inputisinconsistent,discreteandunverified.

  PurposefulexploraEonisminimal–ear/handrequired

.a)  3monthsb)  6months

c)  12monthsd)  2years

AtwhatagedoesEAR/HANDcoordinaPondevelop?

a)  3monthsb)  6months

c)  12monthsd)  2years

AtwhichagedoesEYE/HAND

coordinaPondevelop?

MotorDevelopment

Ear/Hand

Self‐iniEatedmobility

Posture

  ObjectPermanencedelayedbyupto1yr.

  CausalRelaEonship

  Constancy–posiEoninspace

  ClassificaEon–similariEes

  ConservaEon–weight,volume,etc.

CogniPveDevelopment

Social/EmoPonalImpact

 Fear–IsolaEon Lackofopportunity Safety Dependence

ImpactonLanguage

Blindchildrenneedplanned,systemaEc

instrucEon

?

Language(con’t)

  REAL,CONCRETEINDEPENDENTEXPERIENCES

 AlternatestructuredplayenvironmentwithdownEme–quietisok,sEmisok,choiceisok

WhatCanWeDoforYou??

ResourcestoFamilyandProviders

Trainings

TeamSupport

FuncEonalVisionEvaluaEons

APH(AmericanPrinEngHouse)Materials

TransiEonSupport

DBVIEducaPonCoordinators

BristolRegionalOffice:RichardFanisRichard.Fanis@dbvi.virginia.gov(540)642‐7300

NorfolkRegionalOffice:VacantContact:CarenPhipps,RegionalManagerCaren.Phipps@dbvi.virginia.gov(757)858‐6724

RoanokeRegionalOffice:BarbaraHalton‐BaileyBarbara.Halton‐Bailey@dbvi.virginia.gov(540)857‐7122

StauntonRegionalOffice:LisaAuwarterLisa.Auwarter@dbvi.virginia.gov(540)332‐7716

TollFreeNumber:(800)622‐2155

FairfaxRegionalOffice:DeniseWalkerDenise.Walker@dbvi.virginia.gov(703)359‐6736

RichmondRegionalOffice:DonnaCoxDonna.Cox@dbvi.virginia.gov(804)371‐3353

****EDUCATIONSERVICESPROGRAMDIRECTOR****

Glen.Slonneger@dbvi.virginia.gov(804)371‐3113Headquarters–397AzaleaAve.,Richmond,VA

hfp://www.vdbvi.org/educ_services.htm

HandoutProvided

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